Aggressive therapies such as catheter-directed interventions and systemic thrombolysis may be indicated for patients with massive or submassive pulmonary embolism who have hemodynamic compromise or severe symptoms.
May guide selective use in high-risk PE; leaves open optimal strategies and safety pending RCTs.
Pulmonary embolism (PE) and deep vein thrombosis are two elements of the same pathophysiological process referred to as venous thromboembolism. PE occurs when a thrombus migrates from a deep vein to the pulmonary arteries. Although the true incidence of PE is not known, it is estimated that 530,000 cases of PE occur annually in the United States. Clinical presentation varies from asymptomatic (incidentally diagnosed) to fatal. Development of symptoms depends on the embolic burden and the severity of any underlying cardiopulmonary disease. Several treatment options are available for patients diagnosed with PE. The mainstay of treatment is anticoagulation, but given the high mortality associated with some presentations of symptomatic PE, some advocate more aggressive therapy. In this article we discuss such therapies and their potential and appropriate use.
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Nael Saad (2012) studied this question.
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